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Wednesday, June 25, 2014

Medscape Medical News dropped 2
bombs in my inbox last week, and my post-bombing analysis of the papers is that
they both missed the target. Individually, they’re hardly worth a whole column,
so I’ll give them each a third and then share with you a piece of my mind.I’ll need that time to cool off sufficiently.

“Congratulations!
We're Making Strides in Diabetes Care,” by Dr. Anne L.Peters, MD, CDE,
a highly respected diabetologist (of the “old school”), is simply a
cheerleading piece timed for the ADA convention. She gives three links: recent
articles in 1) the Journal of the
American Medical Association (JAMA), 2) the Annals of Internal Medicine, and 3) Diabetes (the Journal of the American Diabetes Association) to
support her “This is great news. We are doing a better job than ever” quote.

Would her
audience, comprised largely of “treating” physicians (like herself,) agree? But
then, maybe that’s the point of her getting ginned up to deliver this
Pollyannaish piece. It seems to me likely that the treating physicians convened
at the Annual ADA Convention are in need of a morale boost.

In spite of
the “strides” claimed (which I don’t dispute), I feel there must be among the
vast majority of practicing physicians a frustration, a frantic despair, in
fact, a feverish frenzy over the failure of the “usual care treatment
protocol,” dictated by their medical associationsand their government overseers. Dr. Peter’s
problem, and that of the entire medical and public health establishment, is
that they simply have the wrong target.

The 2nd
bomb, which appeared just 2 days later, was titled “Diabetes Prevention
Programs: A Waste of Money.” This was a Medscape
Interview of Richard Kahn, PhD (Professor of Medicine, University of North
Carolina, Chapel Hill). A controversial counter message, it focuses, as it
should in my opinion, on “lifestyle modification programs geared for weight
loss,” since these programs have been shown to “delay or prevent the onset of
type 2 diabetes.” The Medscape
Editors note that “as many as 82 million Americans are thought to have
prediabetes.” “These people” (referring to people who had completed a “usual
care” Diabetes Prevention Program) had an enormous amount of attention given by
health professionals.” “Those interventions – almost every one – were
expensive,” Dr. Kahn asserted.

Dr. Kahn
adds: “The first thing you see is that the overwhelming number of studies
didn’t even go out to one year,” and “the assumption the authors make” is “that
that amount of weight can be lost forever. That has simply never been seen
except in bariatric surgery.” “From a medical point of view, it doesn’t look
like that initial weight loss does much, if anything. For some clinical effect
you have to lose substantially more weight – 20%, 25% of your body…,”and, Dr.
Kahn continues, “it would have to stay off for a long time” to be a
cost-effective program worthy of “society pay(ing) for the intervention,” given
“how difficult it is to keep weight off.”

So, Dr.
Kahn’s “after bombing assessment” confirms the ineffectiveness of the “usual
care treatment protocol” you are likely to receive in your clinician’s office
(“wrong target”) and the reason why so many physicians and patients feel frustrated. Dr. Kahn: Under such “diet and
lifestyle” diabetes prevention programs, “the assumption that the weight will
be lost and held off for life… is unrealistic. Or maybe it’s realistic, but
not in today’s world” (emphasis mine). Dr. Kahn isn’t asked about
what he meant by that, but I think I understand: his analysis of the data shows
unproven assumptions and tenets; his conclusion: the presentmodus operendi
(a low-fat, “balanced” diet) is simply not cost-effective.

But Dr.
Kahn does leave a door open to what I suspect he knows about anecdotally, and I
know personally: That long term, permanent weight loss is indeed possible – if we
re-program our bomb sights and set our targets on carbs. He says, “Some
people decide, ‘I’m going to do it. They’ve invested nothing. That’s great for
them, but we’re not arguing about whether people should be encouraged to lose
weight. What we’re arguing against is having society pay the bill for this when it hasn’t been effective.” “The
individual should pick up the cost,” he says. And I say, choose the target
(carbs), and go.

Medscape then asks, “What’s the main takeaway for
clinicians, then?” Dr. Kahn’s final remarks, “People who are overweight or
obese should be strongly encouraged by their healthcare provider to lose weight
and keep it off. If a provider feels that there is a good resource in the
community, he or she should refer the person to that resource.” Hello. Anyone
listening? Check out how I lost and kept off 33% of my body
weight here and here (The Nutrition
Debate #213 & #214).

2 comments:

When "society" pays for weight loss, it's often through drugs or some kind of diet program that costs a lot of money. When you do it yourself, you end up paying less money than you did on a so-called normal diet. I was just noticing this myself, I've been on my low carb, calorie restricted diet now for almost 3 months, and I scarcely ever go to the store anymore. A half gallon of Almondmilk lasts a long time when you're drinking it one-half cup at a time. I buy a 6 oz piece of meat and cut it in half for a serving. The only thing I eat a lot of is salad, and that isn't very expensive. If a person is on a Primal diet that isn't calorie-restricted, they could spend a lot of money on nuts, big cuts of grassfed meat, and a bunch of other things that aren't commonly sold. But generally, when you stop eating carbs, especially the ones that are sold in boxes, your grocery bill will be significantly smaller. So, once again, you are correct. The doctors totally missed the point.

I'm with you on just how far our protein goes at dinner. When we have steak (6-8oz Sam's Club filets), we cut it in half and share one! I like mine with a salad, but Nancy usually makes a fresh vegetable either cooked in garlic and butter, or roasted in olive oil.

About Me

I was diagnosed a Type 2 diabetic in 1986. I started a Very Low Carb diet (Atkins Induction) in 2002 to lose weight. I didn’t realize at the time that it would put my diabetes in clinical remission, or that I would be able to give up almost all of my oral diabetes meds. I also didn’t understand that, as I lost weight and continued to eat Very Low Carb, my blood lipids would dramatically improve (doubling my HDL and cutting my triglycerides by 2/3rds) and that my blood pressure would drop from 130/90 to 110/70 on the same meds.
Over the years I changed from Atkins to the Bernstein Diet (designed for diabetics) and, altogether lost 170 pounds. I later regained some and then lost some. As long as I eat Very Low Carb, I am not hungry and I have lots of energy. And I no longer have any of the indications of Metabolic Syndrome.
My goal, as long as I have excess body fat, is to remain continuously in a ketogenic state, both for blood glucose regulation and continued weight loss. I expect that this regimen will continue to provide the benefits of reduced systemic inflammation, improved blood lipids and lower blood pressure as well.